Effect of pulmonary hypertension on 5‐year outcome of kidney transplantation

Abstract

Pulmonary hypertension affects about one in four patients with advanced chronic kidney disease and significantly increases the risk of death. Kidney transplantation is the recommended management option for patients with progressive or end‐stage kidney disease. However, the resource‐limited nature of kidney transplantation and its intensive peri‐operative and posttransplantation management motivates careful consideration of potential candidates’ medical conditions to optimally utilize available graft organs. Since pulmonary hypertension is known to increase peri‐operative morbidity and mortality among patients living with chronic kidney disease, we performed a retrospective cohort study to assess the impact of pretransplantation pulmonary hypertension on posttransplantation outcome. All patients who underwent single‐organ kidney transplantation at our center in calendar years 2010 and 2011 were identified and the presence of pulmonary hypertension was determined from pretransplantation echocardiography. Outcome was assessed at 5 years following kidney transplantation. Of 350 patients who were included, 117 (33%) had evidence of pulmonary hypertension. The risk of death, graft dysfunction, or graft failure at 5 years after kidney transplantation was higher among those with pulmonary hypertension, primarily owing to an increased risk of graft dysfunction. Importantly, in this institutional cohort of kidney transplant recipients, pretransplant pulmonary hypertension was not associated with a difference in posttransplant survival at 5 years. While institutional and regional differences in outcome can be expected, this report suggests that carefully selected patients with pulmonary hypertension receive similar long‐term benefits from kidney transplantation.

Pulmonary Arterial Hypertension and Adverse Outcomes after Kidney Transplantation: A Systematic Review and Meta-Analysis

“…PH evaluated by using TTE was associated with a higher risk of DGF and early graft dysfunction in some studies, as well [ 25 , 27 ]. However, other studies did not reveal any statistically significant association between pre-existing PH and graft failure ( p = 0.7) [ 21 ] or DGF.…”

“…All included studies were observational and had a retrospective design [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Most studies evaluated echocardiographic parameters as indirect markers of PH [ 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], while only one study included right heart catheterization in PH diagnostic algorithm [ 19 ]. PH was defined by using pulmonary artery systolic pressure (PASP) estimated by TTE in six studies [ 20 , 22 , 23 , 24 , 25 , 27 ].…”

“…PH was defined by using pulmonary artery systolic pressure (PASP) estimated by TTE in six studies [ 20 , 22 , 23 , 24 , 25 , 27 ]. Right ventricular systolic pressure (RVSP), maximum tricuspid regurgitation jet velocity (TRJV), and right ventricular dilation and function were other TTE parameters used in clinical trials to estimate PH [ 18 , 21 , 26 , 28 , 29 ].…”

“…The authors from another study did not report any differences in the 5-year survival rate in KT patients with PH or those without PH ( p = 0.2). Nonetheless, the composite of death, graft dysfunction, or failure was significantly higher in PH patients who underwent KT ( p = 0.001) when compared to those without PH [ 21 ].…”

“…Furthermore, PASP, RVSP, and TRJV were also valuable markers of PH, but cutoff values were also subjugated to variance. Accordingly, RVSP > 50 mmHg, >40 mmHg or ≥35 mmHg cutoffs were used to identify PH patients [ 18 , 21 , 28 ]. Thus, we also performed an analysis of clinical studies that investigated only PASP to reduce the heterogeneity of PH assessment methods.…”